Registration

At Eye Face Institute, our team of surgeons, nurses, medical aestheticians, and administrative staff are committed to providing you with exceptional care throughout your treatment process.

 

If you will take a few minutes to complete the Medical Questionnaire below, this will ensure that all important information is available to us so we can prepare for your upcoming appointment. The contents of your questionnaire are kept strictly confidential in accordance with our Privacy Policy.

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*Please check the expiry date of your health card to make sure it is valid prior to your appointment.



NoneYes


Non-smokerEx-smokerCurrently smoking



NoneAny


NoneAny



NoneAny


NoneAny



NoYes


NoYes





Thank you for taking the time to complete this form. Please read it over to make sure the information is accurate and then [click on Submit] to submit it to Eye Face Institute by secure email.

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